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Hospitals Balance COVID, Critical Care, Routine Conditions

Five months into the coronavirus pandemic, Orange County’s largest hospital systems say they are now better prepared to treat patients, both with COVID-19 and other health conditions.

Because an initial, feared surge in April did not come to pass, hospital execs say they had time to secure personal protective equipment, learn more effective treatment methods, secure new therapies for patients and enhance safety protocols that will likely endure for the rest of the year.

Organizations continue to recommend patients concerned about COVID-19 call ahead, and many have bolstered telehealth programs to address primary care and routine health check-ins.

At the same time, hospitals have come together to urge residents to seek care for other critical conditions, which include scheduled surgeries that were postponed and emergencies such as strokes and heart attacks that require immediate attention.

In many cases, “patients deferred because fear became a huge determination in their mind. As a result, we saw conditions that should have been treated much earlier,” said Robert Braithwaite, chief executive of Hoag Memorial Hospital Presbyterian. “Please know that we’ve taken measures to create a safe environment.”

To that end, hospitals have also increased their presence on social media to alert residents to signs of serious health conditions, and to communicate disinfection protocols and mask enforcement, among other requirements.

Chad Lefteris, chief executive of UCI Health said, “competitors have come together with a unified and consistent message reminding people to get the care they need.”

There are promising signs of a return to near-normal patient and procedures volumes, officials said.

Below, local healthcare leaders address their readiness to support the health needs of the community in a safe and controlled environment.

Hoag

A recent surge in COVID-19 patients didn’t take Hoag by surprise.

“We watched our county loosen up and start enjoying social events, and we had a distinct feeling that we would see a spike. And what we’ve seen in the past few weeks mirrors a near-perfect epidemiological curve,” Braithwaite said.

Still, he said OC’s second-biggest hospital is well prepared to screen, test and treat COVID-19 patients with adequate protective equipment, while also providing safe and segregated care for patients with other health issues.

“Hoag treated [its] first COVID-19 patient in the U.S. on Jan. 25. We’ve learned a lot since then,” Braithwaite said.

Lessons that come to his mind on a more macro scale include being more mindful of communities around the world and how their healthcare challenges can have an impact on the local community, as well as the fact that healthcare providers need to act with urgency as science informs clinicians and influences treatment methods.

Internally, patients have responded well to remdesivir and convalescent plasma, he said, noting that studies have proven remdesivir lowers the length of hospital stays for COVID-19 patients, though data on how it affects mortality rates has not been published.

As for Hoag’s operations, Braithwaite said it’s moved to a proactive posture—in his own words “from the heels to balls of our feet”—in terms of clinical and financial planning.

Hoag is also on the upswing from a financial perspective; it has reopened for elective procedures and brought back about three-fourths of its 400 furloughed workers. It also started hiring for new roles that focus on community outreach and patient advocacy.

“April was our floor and now we’re in our recovery phase,” Braithwaite said.

“Hoag is strongly positioned with the amount of knowledge we’ve obtained since January, as well as the therapies we have in place. My confidence in our staff to take care of COVID-19 patients is very high.”

Kaiser

Kaiser Permanente never ramped down its COVID-19 protocols, so it was well equipped to handle an uptick in patients in recent weeks.

“Fortunately, Kaiser did not undo all the preparation work we undertook in February, March and April, to treat the pandemic as it began and braced for the worst,” said Mark Costa, senior vice president and area manager for Kaiser’s local operations, including OC’s third-largest hospital.

Measures in place include a national command center and changes to double capacity and care for hospitalized patients across its organization, he said.

Kaiser’s emergency departments at both area medical centers have special units that are solely used Patients Under Investigation, also known as PUIs. In each pod it has 12 beds for a total of 24.

It continues to adapt its clinics for various member needs such as drive-thru tests and prescription pickups.

It also reopened for elective procedures in June.

Looking ahead, Costa said as a result of its preparations, “we are now in a strong position to identify and predict potential hot spots and surges of patients seeking high-level care for COVID-19.”

In addition, he emphasized residents “help us fight future spikes and alleviate capacity issues at our hospitals” by following “the state mandate of wearing a mask,” in addition to social distancing and staying home when possible. Costa said, “The care and safety of our members, patients and staff remains our highest priority, but we must work together to combat this virus as a community.”

MemorialCare

Fountain Valley-based MemorialCare Health System, with four hospitals and 200 clinics throughout Southern California, said the majority of its COVID-19 patients are able to recover at home.

Chief Executive Barry Arbuckle attributed this to “our early leadership in virtual care and telehealth,” which has “advanced significantly over the last months.” It has conducted 70,000 telehealth visits since March.

MemorialCare offers options for text messaging and a virtual Triage Bot powered by artificial intelligence.

“Exciting technologies adopted by MemorialCare are translating into new realms of hope and health—coming together to deliver more efficient care, reaching patients where they are and ensuring best in-class healthcare becomes a more seamless part of daily life,” Arbuckle said.

On the research front, two treatments have proven effective for hospitalized patients, though there remains no evidence-based treatment for patients with milder COVID-19 conditions, officials said.

Remdesivir was shown to reduce a patient’s average recovery time from 15 to 11 days on average, however the clinical trial was halted before clinicians could draw a conclusion about a reduction in mortality rates.

A more recent trial on corticosteroid dexamethasone showed it significantly reduced mortality in patients requiring ventilation by 28.7% and in patients requiring supplemental oxygen by 14%.

Because MemorialCare’s coronavirus patients have made up a single-digit percentage of its bed capacity on each campus, the system was able to continue to care for all other patients, Arbuckle said.

It performed necessary surgeries and managed care for medical conditions such as diabetes, cancer, heart disease, orthopedic and delivering babies throughout the shutdown.

Patients have now started to return more gradually for important screenings and routine appointments.

MemorialCare’s finances have been strained in recent months, like other health systems across the county, though its Long Beach medical center received about $12 million from the Department of Health and Human Services in the second round of federal aid for hospitals in COVID-19 high-impact areas.

Nevertheless, Arbuckle said the hospital continues to invest in the safety of its business.

He said, “We’re fortunate to have a strong balance sheet, one of the highest credit ratings in California and a long history of financial stability to sustain a crisis like this.”

Providence

“COVID-19 does not distinguish among us … it can result in death for even the healthiest among us,” said Chief Executive Erik Wexler, who oversees Providence’s Southern California hospital system, who noted cases in younger adults have been rising in recent weeks.

Wexler urged residents to wear a mask and physically distance to prevent the spread of COVID-19 with autumn around the corner, as well as seek care for routine needs—like the flu shot.

Providence continues to screen everyone who enters its facilities and requires universal masking, strict visitor limitations and has triage points for COVID-19 patients and those exhibiting symptoms, officials said.

In the event of a larger surge, Providence said it has the ability to deploy personal protective equipment from one location to another and to expand to 140% of normal capacity if needed.

An unfortunate result of the shutdown was that patients delayed care for outpatient or elective procedures, which included critical surgeries that should have been categorized differently, Wexler said.

Providence saw a massive reduction in these procedures, including for example the removal of a tumor.

The hospital system has also faced financial stress on three fronts, due to “revenue loss from essential and elective procedures, fear among the public to seek care even for critical situations, as well as the premium price it has paid to secure PPE,” Wexler said.

Records indicate St. Joseph Hospital-Orange received about $13.7 million in high-impact area funding; Providence Holy Cross Medical Center in Mission Hills saw north of $25 million and St. Jude Neighborhood Health Centers, an affiliate of St. Jude Medical Center, both in Fullerton, received $852,290 in supplemental funding.

Still, Wexler said the funds have only offset about half of its financial decline. Ultimately, “we expect to recover from this downturn but we recognize it will take some time to get back to pre-COVID rhythms.”

UCI Health

The county’s largest hospital and OC’s only academic medical center, UCI Health, believes it already hit its summer peak with 69 coronavirus patients in July; it’s down to about 50 at press time.

Still, CEO Lefteris says it continues to prepare for the worst and lend a helping hand to overburdened health systems, county-owned facilities and senior care homes via testing and contract tracing programs.

“When this started, we had two options: hunker down or ramp up and figure out how to meet the needs of the community,” Lefteris said. “And we have met those needs.”

UCI Medical Center was the first to offer COVID-19 tests in the county, and it continues to ramp capacity while reducing turnaround times. It’s now clocking in about 2,000 tests per day and expects to perform 3,000 tests per day by early September.

It’s also planning for the future by securing protective equipment, testing supplies and even materials that would support a vaccine program when one comes along, officials said.

Meanwhile, elective procedure volumes have returned to near-regular levels and emergency room visits for non-coronavirus care are trending up.

Lefteris said he still worries about a health crisis “around what happened to so many people who prolonged treatment,” noting that studies show that 911 calls are down, resulting in more deaths at home.

“That tells me people aren’t coming into the emergency room as much and that makes me nervous,” he said.

UCI Health entered the pandemic “with a very strong hand” and has had no furloughs or layoffs related to COVID-19, though rebounding procedure levels have been beneficial to the institution’s financial well-being.

Ambulatory clinics and inpatient census have returned to pre-COVID levels, Lefteris said.

UCI received $9.7 million in federal aid as a designated high-impact area.

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